A clinical overview: Obstructive sleep apnea and hypertension

SummaryObstructive sleep apnea is now increasingly being linked as risk factor for cardiovascular disorders and T2DM, although there is a distinct need for harder evidence. Whether this is an independent association or though its relationship with the cluster of risk factors associated with the metabolic syndrome, remains to be proven. Amongst this cluster of confounders, the association between obstructive sleep apnea (OSA) and diurnal hypertension, has been the most investigated and in this brief review, we look at the strength, or otherwise, of this relationship. Although much is known about the patho-physiology of hypertension, one must accept that there are areas which are still “grey”. Can OSA explain some of these grey areas? Moreover, one does come across many cases of what has been termed as “resistant” hypertension which does not come under optimal control in spite of the use of the best available management strategies. Could OSA be the cause of this resistance? Where precisely do we stand when faced with a patient of hypertension in clinical practice in so far as investigating for the presence of OSA and what severity should we treat this co-morbid condition, as it would not seem feasible, medically, economically or even practically, to put all patients with hypertension through tests of polysomnography and CPAP therapy.